The beauty of the Royal Commission into Aged Care Quality and Safety is not in its findings - these are damning - but in the vision and hope that it paints.
“The purpose of the aged care system must be to ensure that older people have an entitlement to high quality aged care and support and that they must receive it. Such care and support must be safe and timely and must assist older people to live an active, self-determined and meaningful life in a safe and caring environment that allows for dignified living in old age.”
We recommend a new aged care program aimed at achieving seven essential outcomes:
- Person-first - care and supports which address physical, social, psychological, cultural and spiritual needs, supporting people to function independently for as long as possible.
- Simplicity - one aged care program, one set of eligibility criteria and one assessment process.
- Accessibility - information that is easy to locate and understand with face-to-face supports.
- Universal Entitlement - once entitled to care, guaranteed access to the care and supports assessed as needed.
- Timeliness - assessments and reassessments of need occur when required and services commence within one month of assessment.
- Choice of settings - in the home, community and residential care.
- Inclusiveness - recognition of a person’s diverse characteristics and delivery of culturally safe and trauma-informed care.
[Vol 1, Pg 97]
This is not however today's experience.
The findings of the Aged Care Royal Commission indicate clearly the ways in which our current system has severely let down many in care or who are in need of care. Five systemic issues highlighted in Volume One of the report and expanded upon in Volume Two are:
- Those who need home care can't get it. Wait times can be up to 34 months.
- The standard of care the Homecare packages provide is inadequate. People receiving the highest level of care at home, on average, get only eight hours and 45 minutes of service a week while those on other packages can be getting three hours.
- Staffing levels are too low. This results in meaningful, relationship based care often being replaced by transactional interactions.
- The system is failing those requiring ‘special care’ such as in rural areas or Aboriginal and Torres Strait Islanders.
- The aged care system is not well integrated with the healthcare system meaning those in care often receive substandard care when they have medical challenges.
The report identifies systemic issues around government funding models, overall governance and responsibility that have contributed to the poor levels of care and access to care.
Ross Gittens sums it all up in his article in the SMH - “All the specific problems stem from a single cause: we’ve gone for decades – under federal governments of both colours – trying to do aged care on the cheap, and it’s been a disaster.”
Yet the reality is we also need to do a lot better with what we have and this is the opportunity many organisations are missing.
TAKING ACTION - TECHNOLOGY
There are 148 recommendations in the report. Technology is part of those recommendations [Number 109, Vol 1, Pg 283].
Many of the initiatives will need to be led by the government, however providers play a key role and many of those we have been working with are already well ahead of the curve when it comes to how they are using technology as they seek to provide outstanding care.
Section 1.3.15 Improving aged care through data, research and technology outlines the suggested direction: “The aged care system that we envisage will need to operate in a technology-enabled environment for efficient clinical, business and operational systems. These need to be designed to identify older people’s needs and preferences and to provide care tailored most effectively to their needs.”
[Vol 1, Pg 147]
GET THE RIGHT SYSTEMS IN PLACE
First, the systems should be designed to enable better services for older people. This should include a new service-wide client relationship management system for care management, case monitoring and reporting systems built around older people’s care. Data and information should be accessible, accurate and up-to-date, and there should be standardised systems and tools to make the user experience easy and efficient.
[Vol1, Pg 149]
‘Person first care’ is part of the vision. For a new aged care system. If your systems are not set up with the person at the centre then you are already perpetuating a culture that elevates the organisation over the person.
You need to have a system that brings together all that you know about a person in one place. That system should enable that person and their loved ones to make choices for them in a timely manner about the type and style of care they are getting and that recognises individual difference.
A great system will make it easy for your staff to enter information just once that is then visible to all others that are supporting the care of each person. That data can then be easily leveraged and studied to identify trends, drive more effective care and ensure the quality of care for each individual.
Your system should make it easy for issues to be captured, responded to in a timely manner and reported on. It should provide you with a one touch method for creating plans for continuous improvement and seeing them through to completion.
LEVERAGE SMART TECHNOLOGY
Second, increased investment is needed in pre-certified assistive technologies and smart technology to support care and functional needs of older people, and help manage their safety and contribute to their quality of life.
[Vol1, Pg 149]
A key finding of the Commission was the lack of specialist care that was being accessed particularly by those in residential care. Telehealth is a simple example of an assistive technology and a way to start to solve this in certain circumstances where it is an appropriate way to get the right care to the person.
The NACA RESEARCH PAPER: Assistive Technology for Older Australians identified ‘The AT ‘clusters’ which evidenced effectiveness were assistive technologies in clusters, namely, chronic disease management/ telemedicine; sensor technologies for falls prevention; ICT for dementia; use of robotics, general ICT and telemonitoring for wellbeing; sensor technologies for independent living; robotics and ICT for communication and emotional support, and medication management systems.’
Where possible, extracting the data from these technologies along with connecting existing devices and medical care systems and leveraging other smart technologies will contribute further to the single view of the person and keep them safer and enhance their quality of life.
CONNECT YOUR SYSTEMS
Third, there should also be investment in systems that talk to each other and allow for seamless systems for reporting. There should be interoperability of information and communications systems. This would enable the sharing of data and information about people accessing aged care between aged care and health care providers and relevant government agencies.
[Vol1, Pg 149]
Reports into 911 showed that the FBI had all of the information it needed to stop an attack. However, their systems were at times paper based and at other times disconnected and so the right information was not put together in a timely fashion, the opportunity was missed and lives were lost. Many aged care facilities and services are the same.
Within your organisation your own data must be connected. Your systems need to be connected so that your operational systems talk to your clinical systems and your businesses systems. Get this right and administrative costs come down, staff have the data available to them that they need in one place at the right time and ultimately the level of care improves.
We have seen situations where care being provided to a patient by one part of an organisation is not known about by another part of an organisation. In other situations hours and hours of care time is lost as staff hunt down important information that is not easily accessible.
Your systems also need to be able to talk to the outside world. There is no point building closed systems. The future will require you to be able to pass data easily back to relevant authorities.
We all know that technology is not a solution but it has a role to play. There is the chance to do better with the resources we have as well as hopefully get the funding to do even more.
Technology used well can:
- Enable people to stay in their homes longer.
- Provide more equitable access to care.
- Provide a holistic picture of the care being received.
- Free staff of administrative burdens allowing more time for care.
- Enable effective timely reporting on data to ensure continuous improvement and enhanced care and much more.
However, many organisations struggle to execute well in this space. They have no clear roadmap and often end up with good point solutions that do not talk together.
You can read more about forming your approach to these challenges in our eBook Embracing the Digital Future of Aged Care.